Teleneurorehabilitation program (virtual reality) for patients with balance disorders: descriptive study

Abstract Background Balance disorders are common in patients with neurological or vestibular diseases. Telerehabilitation program is a treatment to be as safe as conventional treatment. One of the most used methods to perform telerehabilitation is the incorporation of Virtual Reality. In general, rehabilitation programs train predictive postural control, so the patient does not always acquire the necessary autonomy to react to situations of instability. On the other hand, the objective and systematic supervision and measurement of these programs is limited, making it necessary to create clinical protocols with precise and measurable rehabilitation objectives. This study present the training selection methodology and clinical protocol for patients with balance disorders inserted in a Telerehabilitation Program based on Virtual Reality. Methods Descriptive study where physiotherapists were trained to use RehaMetrics®. To evaluate their level of agreement in the selection of the exercise clusters developed, the Interobserver Reliability was measured through the kappa statistic. Subsequently, the exercises were applied to a group of patients recruited with sedentary trunk control (Berg Balance Scale = 3 points in item 3), mild or normal cognitive level (Montreal Cognitive Assessment> 21 points), and prescribed for tele-rehabilitation by a doctor. Results The agreement among the expert physiotherapists irrespective of the cluster exceeds 80%, which indicates a very good strength of agreement, while the novices reached a level of agreement of 45%, which suggests a moderate strength of agreement. All clinical outcomes showed statistically significant differences between the median times, as did the Maximum Width Left Side (MWLS) (cm). The average number of minutes of training was 485.81 (SD 246.49 min), and the number of sessions performed during the 4 weeks of intervention was 17 (SD 7.15 sessions). Conclusions This analysis what had excellent interobserver reliability with trained physiotherapists. Regarding the second phase of the study, the results show a statistically significant difference between the initial and final evaluation of the clinical tests, which could result in better performance in aspects such as: balance, gait functionality, meter walked and cognition. Telerehabilitation Program based on Virtual Reality is an excellent alternative to provide continuity of treatment to patients with balance disorders.

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Comparison of Morphological Similarities and Differences between Liquid-Based Cytology and Conventional Techniques of Serous Effusion Cytology Specimens

Acta Cytologica ◽

10.1159/000521052 ◽

2021 ◽

pp. 1-6

Author(s):

Nurhan Baykus ◽

Selver Özekinci ◽

Zeynep Betul Erdem ◽

Eren Vurgun ◽

Fetin Rustu Yildiz

Keyword(s):

Morphological Analysis ◽

Kappa Statistic ◽

Structural Features ◽

Conventional Technique ◽

Serous Effusion ◽

Significant Difference ◽

Microscopic Feature ◽

Liquid Based Cytology ◽

The Relationship ◽

Level Of Agreement

Introduction: The aim of this study is to discover a fast and efficient method for the diagnosis of serous effusion cytology specimens by comparing the cytomorphological features of SurePath (SP) smears and smears prepared by cytospin. After the macroscopic features of the incoming material were recorded, it was divided into 2 for conventional technique (CT) and liquid-based technique. Cytospin was used for CT and SurePath for liquid-based technique in this study. Materials and Methods: 243 serous effusions (33 thoracentesis and 92 paracentesis fluids, 118 peritoneal lavage fluids) were investigated. After shaking the effusion gently, it was centrifuged for 5 min at 1,250 rpm for cytospin smear. SP smear was prepared according to the “BD PrepStain slide processor”. Two smears were prepared with these 2 methods and then stained with Papanicolaou. The smears were examined under a light microscope in terms of fixation, background, cellularity, nucleus, and structural features. All statistical analysis of the data was performed using the SPSS 17.0 software. For each microscopic feature, the χ2 test was used to assess the significance of the relationship between cytospin and SP, and level of agreement in between the methods was assessed using the kappa statistic. Results: A statistically significant difference was observed between the 2 methods in background (p < 0.001), cellularity (p < 0.001), nucleus features (p < 0.001), and structural features (p < 0.05). There was no significant difference in fixation. Low level of agreement was observed with the kappa statistic in fixation, background, and cellularity. Moderate level of agreement was observed in the nucleus and structural feature groups with the kappa statistic. Discussion/Conclusion: Although there are advantages of liquid-based technique such as standardized fixation and cleaner background, since the cellular and background components required for morphological analysis and diagnosis are better preserved in cytospin, it is considered to be better to use liquid-based technique not alone but together with CT.

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Agreement Between Dribble and Change of Direction Deficits to Assess Directional Asymmetry in Young Elite Football Players

Symmetry ◽

10.3390/sym12050787 ◽

2020 ◽

Vol 12 (5) ◽

pp. 787 ◽

Cited By ~ 1

Author(s):

Athos Trecroci ◽

Tindaro Bongiovanni ◽

Luca Cavaggioni ◽

Giulio Pasta ◽

Damiano Formenti ◽

...

Keyword(s):

Kappa Statistic ◽

Potential Difference ◽

Directional Asymmetry ◽

Football Players ◽

Cohen’S Kappa ◽

Change Of Direction ◽

Task Specificity ◽

Cohen's Kappa ◽

Significant Difference ◽

Level Of Agreement

This study aimed to examine the agreement between asymmetries of dribble and change of direction (COD) deficits and to determine their potential difference to each other. Sixteen young elite football players were recruited and tested for sprint (over 10 m), dribbling (90°CODdribbling) and COD (90°CODrunning) performance in dominant (fastest) and non-dominant (slowest) directions. Dribble and COD deficits were computed to express dribbling and COD ability without the influence of acceleration. The asymmetric index (AI%) of both dribble and COD deficits were obtained for both directions. The level of agreement between dribble and COD deficits was assessed by Cohen’s kappa statistic (κ). Results showed that AI% measured by dribble and COD deficits presented a poor level of agreement (κ = −0.159), indicating their imbalance did not favor the same direction. Moreover, AI% of the dribble deficit was significantly higher than those of the COD deficit. This study demonstrated that asymmetries in dribbling and change of direction performance (measured by dribble and COD deficit) were not in agreement to favor the same direction, also displaying a significant difference to each other. Practitioners should consider the task-specificity of asymmetry to reduce the imbalance in dribbling and COD performance.

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A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211009861 ◽

2021 ◽

pp. 1357633X2110098

Author(s):

Aya Sedky Adly ◽

Afnan Sedky Adly ◽

Mahmoud Sedky Adly ◽

Mohammad F Ali

Keyword(s):

Rheumatoid Arthritis ◽

Virtual Reality ◽

Elderly Patients ◽

Aerobic Exercise ◽

Health Professionals ◽

Post Treatment ◽

Laser Acupuncture ◽

Virtual Reality Training ◽

Significant Difference ◽

Elderly Onset

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this study was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group ( p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments ( p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups ( p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group. Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

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Smart Health System to Detect Dementia Disorders Using Virtual Reality

Healthcare ◽

10.3390/healthcare9070810 ◽

2021 ◽

Vol 9 (7) ◽

pp. 810

Author(s):

Areej Y. Bayahya ◽

Wadee Alhalabi ◽

Sultan H. AlAmri

Keyword(s):

Virtual Reality ◽

Clinical Diagnosis ◽

Kappa Statistic ◽

Weighted Kappa ◽

Health Technology ◽

P Value ◽

Functional Evaluation ◽

Medical Specialties ◽

Weighted Kappa Statistic ◽

Smart Health

Smart health technology includes physical sensors, intelligent sensors, and output advice to help monitor patients’ health and adjust their behavior. Virtual reality (VR) plays an increasingly larger role to improve health outcomes, being used in a variety of medical specialties including robotic surgery, diagnosis of some difficult diseases, and virtual reality pain distraction for severe burn patients. Smart VR health technology acts as a decision support system in the diseases diagnostic test of patients as they perform real world tasks in virtual reality (e.g., navigation). In this study, a non-invasive, cognitive computerized test based on 3D virtual environments for detecting the main symptoms of dementia (memory loss, visuospatial defects, and spatial navigation) is proposed. In a recent study, the system was tested on 115 real patients of which thirty had a dementia, sixty-five were cognitively healthy, and twenty had a mild cognitive impairment (MCI). The performance of the VR system was compared with Mini-Cog test, where the latter is used to measure cognitive impaired patients in the traditional diagnosis system at the clinic. It was observed that visuospatial and memory recall scores in both clinical diagnosis and VR system of dementia patients were less than those of MCI patients, and the scores of MCI patients were less than those of the control group. Furthermore, there is a perfect agreement between the standard methods in functional evaluation and navigational ability in our system where P-value in weighted Kappa statistic= 100% and between Mini-Cog-clinical diagnosis vs. VR scores where P-value in weighted Kappa statistic= 93%.

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Developing a virtual reality for people with dementia in nursing homes based on their psychological needs: a feasibility study

BMC Geriatrics ◽

10.1186/s12877-021-02125-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jung-Hee Kim ◽

Seonmin Park ◽

Hyeongji Lim

Keyword(s):

Virtual Reality ◽

Nursing Homes ◽

Intervention Program ◽

Psychological Symptoms ◽

Likert Scale ◽

Psychological Needs ◽

Second Phase ◽

People With Dementia ◽

The Mean ◽

Behavioral And Psychological Symptoms

Abstract Background The purpose of this study was (1) to develop a virtual reality (VR) intervention program based on the psychological needs of patients residing in nursing facilities in South Korea to alleviate their behavioral and psychological symptoms and (2) to confirm the possibility of utilizing VR in patients with dementia. Methods In the first phase, patients with dementia residing in nursing homes and experiencing behavioral and psychological symptoms were recruited. Surveys and questionnaires were used to identify activities that alleviated the behavioral and psychological symptoms of dementia (BPSD) among the patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. Patients with dementia experienced the VR content. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR using a 5-point Likert scale. Results In the feasibility test, 10 nursing home residents were recruited. The mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points using a 5-point Likert scale. Higher mean scores indicated a more positive outcome. Six of the 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 min. Conclusions The VR-based intervention program that was developed to reduce BPSD was feasible for the participants and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings support the potential use of VR-based BPSD intervention programs to treat patients with dementia.

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Inter-Limb Jump Asymmetries and Their Association with Sport-Specific Performance in Young Male and Female Swimmers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147324 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7324

Author(s):

Max I. Phukan ◽

Rohit K. Thapa ◽

Gopal Kumar ◽

Chris Bishop ◽

Helmi Chaabene ◽

...

Keyword(s):

National Level ◽

Young Male ◽

Front Crawl ◽

Male And Female ◽

Standing Long Jump ◽

Significant Difference ◽

Specific Performance ◽

Long Jump ◽

Males And Females ◽

Level Of Agreement

This study aimed to examine inter-limb jump asymmetries and their association with sport-specific performance in young swimmers. Thirty-eight (male, n = 19; female, n = 19) regional/national level young swimmers (age: 12.3 ± 1.2 years; height: 159.6 ± 8.2 cm; body mass: 52.5 ± 9.2 kg) participated in this study. Inter-limb asymmetries were assessed for single-leg countermovement jump (SLCMJ) and single-leg standing long jump (SLSLJ). Sport-specific performance was evaluated using front crawl (i.e., 50 m and 25 m) and front crawl kick (i.e., 50 m and 25 m). The kappa coefficient revealed a “slight” level of agreement (Κ = 0.156, 0.184, and 0.197 for female, male, and all, respectively) between the direction of asymmetry for SLCMJ and SLSLJ, indicating that asymmetries rarely favored the same limb during both tests. A paired sample t-test showed a significant difference (p = 0.025) between asymmetry scores obtained in SLCMJ and SLSLJ. No significant difference was found in asymmetry scores between males and females (p = 0.099 to 0.977). Additionally, no association between asymmetry scores and sport-specific performance was observed (p > 0.05). Our findings highlight the independent nature of inter-limb asymmetries derived from SLCMJ and SLSLJ among young male and female swimmers. Further, our results suggest no association between jumping asymmetries and sport-specific performance.

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Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam

Brazilian Dental Journal ◽

10.1590/s0103-64402011000200007 ◽

2011 ◽

Vol 22 (2) ◽

pp. 129-133 ◽

Cited By ~ 3

Author(s):

Patrícia Lima Moreira ◽

Michel Reis Messora ◽

Stela Márcia Pereira ◽

Solange Maria de Almeida ◽

Adriana Dibo da Cruz

Keyword(s):

Interobserver Reliability ◽

Negative Influence ◽

Composite Resins ◽

Wilcoxon Test ◽

Vertical Angle ◽

Human Teeth ◽

Radiographic Images ◽

Secondary Caries ◽

X Ray ◽

Significant Difference

The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (Az), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (Az=0.66, Filtek-Z250>Az=0.56, TPH-Spectrum) compared to 0º (Az=0.55, Charisma>Az=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.

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The Effects of Virtual Reality on Upper Extremity in Patients with Obstetric Brachial Plexus Injury

Journal of Pediatric Neurology ◽

10.1055/s-0041-1724100 ◽

2021 ◽

Author(s):

Havva Ezgi Karas ◽

Emine Atıcı ◽

Gamze Aydın ◽

Mert Demirsöz

Keyword(s):

Virtual Reality ◽

Brachial Plexus ◽

Upper Extremity ◽

Brachial Plexus Injury ◽

Control Group ◽

Nintendo Wii ◽

Significant Difference ◽

Obstetric Brachial Plexus ◽

Conventional Physiotherapy ◽

Obstetric Brachial Plexus Injury

AbstractThe present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality (p < 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG (p < 0.05). There was no significant difference in the MSS values of either groups (p > 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly (p < 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI. Clinical Trials Number NCT04605601.

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Immersive and Non-Immersive Virtual Reality Distraction on Pain Perception to Intraoral Injections

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-45.6.5 ◽

2021 ◽

Vol 45 (6) ◽

pp. 389-394

Author(s):

Supriya Kumari ◽

Rachana Bahuguna ◽

Nishita Garg ◽

Ramakrishna Yeluri

Keyword(s):

Virtual Reality ◽

Pain Perception ◽

Dental Treatment ◽

Immersive Virtual Reality ◽

Dental Procedures ◽

Group I ◽

Significant Difference ◽

The Mean ◽

Group Ii ◽

Chi Square Analysis

Objective: To evaluate the efficacy of immersive VR (IVR) and non-immersive VR (NIVR) distraction on perceived pain during intraoral injections in children undergoing dental procedures. The objective was to introduce 3-dimensional nature of virtual reality during the provoking phase of dental treatment as a means of distraction in children. Study design: A total of 200 children were selected for the study, 100 for IVR group and 100 for NIVR group. After randomization, children were introduced to Oculus Go Standalone equipment; MCDAS (f), VAS, WBFRS and the treatment procedure using tell show do technique. Group I children were introduced to oculus go standalone headset with hand held controller to play temple run or roller coaster game while in group II, children watched cartoon movies of their choice. Pre-operative & post-operative MCDAS scores were obtained using MCDAS (f) questionnaire in local language. Post-operatively, VAS and WBFRS scores were also obtained. The data was analyzed using independent t-test and chi-square analysis. Results: Pre-operatively, the mean MCDAS scores were similar in both the groups viz. Group–I (29.20 ± 3.197) and Group–II (29.09 ± 3.803) and is statistically not significant. Post-operatively, the mean MCDAS scores were higher in non-immersive group (20.72 ± 2.822) as compared to immersive group (10.99 ± 2.227). VAS score was higher in non-immersive group (2.72 ± 0.99) as compared to immersive group (0.75 ± 0.88). WBFRS scores were higher in non-immersive group (2.78 ± 1.097) as compared to immersive group (0.82 ± 1.104). Conclusion: Three-dimensional virtual reality was found to be an effective means of distraction in children undergoing dental procedures and especially during the provoking phase. The significant difference obtained clearly indicates irrespective of immersiveness of virtual reality, anxiety had been decreased and on comparison the pain perception to intraoral injection is less in immersive virtual reality environment. Immersive VR distraction technique can serve as an adjunct to traditional behavior management strategies already available to the pediatric dentist.

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Urinary fluoride excretion in children exposed to fluoride toothpaste and to different water fluoride levels in a tropical area of Brazil

Brazilian Dental Journal ◽

10.1590/s0103-64402008000300007 ◽

2008 ◽

Vol 19 (3) ◽

pp. 214-218 ◽

Cited By ~ 9

Author(s):

Franklin Delano Soares Forte ◽

Suzely Adas Saliba Moimaz ◽

Fábio Correia Sampaio

Keyword(s):

Dental Fluorosis ◽

Fluoride Concentration ◽

Second Phase ◽

Appropriate Use ◽

Fluoride Toothpaste ◽

Tropical Area ◽

Significant Difference ◽

Urinary Fluoride ◽

The City ◽

Water Fluoride

The aim of this study was to evaluate the urinary fluoride excretion of 2- to 7-year-old children exposed to different water fluoride concentrations in the city of Catolé do Rocha, PB, Brazil. Forty-two children were allocated to 3 groups according to the concentration of fluoride in the water: G1 (n=10; 0.5-1.0 ppm F), G2 (n=17; 1.1-1.5 ppm F) and G3 (n= 15; >1.51 ppm F). The study was carried out in two 1-week phases with 1-month interval between the moments of data collection: in the first phase, the children used a fluoride toothpaste (FT) (1,510 ppm F) for 1 week, whereas in the second phase a non-fluoride toothpaste (NFT) was used. The urine was collected in a 24-h period in each week-phase according to Marthaler's protocol. The urinary fluoride excretion data expressed as mean (SD) in µg/24 h were: G1-FT= 452.9 (290.2); G1-NFT= 435.1 (187.0); G2-FT= 451.4 (224.0); G2-NFT= 430.3 (352.5); G3-FT=592.3 (390.5); and G3-NFT=623.6 (408.7). There was no statistically significant difference between the water fluoride groups, and regardless of the week phase (ANOVA, p>0.05). The use of fluoride toothpaste (1,510 ppmF) did not promote an increase in urinary fluoride excretion. There was a trend, though not significant, as to the increase of urine fluoride concentration in relation to fluoride concentrations in the water. The excretion values suggest that some children are under risk to develop dental fluorosis and information about the appropriate use of fluoride is necessary in this area.

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